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PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

In blind loop syndrome a portion of the small intestine becomes bypassed and thus cut off from the normal flow of food. This may lead to malabsorption and small intestinal bacterial overgrowth (SIBO) syndrome. It may also be associated with short bowel syndrome.

Pathophysiology

Obstruction to the normal passage of food through the affected segment leads to ineffective bile salt digestion of fats and fat-soluble vitamins. The stagnant food ferments, with associated bacterial overgrowth.[1]

SIBO is often a recurrent disorder, depending on the nature of any predisposing condition.

The most common diagnostic tool is represented at present by a hydrogen breath test. However, the gold standard for diagnosis of SIBO is aspiration and direct culture of the jejunal aspirate.

Management is with antibiotic treatment and management of any underlying cause. Many different antibiotics have been advocated but there is no consensus regarding the most effective antibiotics or duration of treatment.

In addition to antibiotic treatment, prebiotics or probiotics have been studied:

Management

The treatment of SIBO syndrome usually includes the eradication of bacterial overgrowth with a repeated course of antimicrobials, correction of associated nutritional deficiencies and, when possible, correction of the underlying predisposing condition.[5]

The underlying cause should be corrected if possible - eg, surgical correction.

In many cases surgery is not an option and therapy has two aims:

Tackle bacterial overgrowth:

Antibiotics are used and may be required for long periods of time.

The most common antibiotics used are the tetracyclines - eg, oxytetracycline; however, it is estimated that up to 70% will fail to respond to this.

There have been some promising results with rifaximin, which is a non-absorbable antibiotic; however, this is not more superior to metronidazole, which should be used as an alternative if there is lack of success with the tetracyclines.[6]

Development of resistance is a problem and antibiotics may need to be changed frequently.

Probiotics help in animal studies but their role in humans with bacterial overgrowth is yet to be established.[7]

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.